Transplant Decision Too Late, Teen Dies

Insurer Initially Refused To Pay For Liver Transplant; Girl Dies After Procedure Approved

(CBS/AP)  A 17-year old died just hours after her health insurance company reversed its decision not to pay for a liver transplant that doctors said the girl needed.

Nataline Sarkisyan died Thursday night at about 6 p.m. at University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

"She passed away, and the insurance (company) is responsible for this," she said.

The family is planning to sue the insurance company, their attorney said Friday.

Attorney Mark Geragos said he also plans to ask the district attorney to press murder or manslaughter charges against CIGNA HealthCare for the death of Nataline Sarkisyan.

The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said at a news conference outside his downtown Los Angeles office. He did not say when or in what court he would file the suit.

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail.

Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant.

CIGNA stated her plan did not cover "experimental, investigational and unproven services," her doctors said, reports CBS News station KCBS-TV.

On Thursday, about 150 teenagers and nurses protested outside CIGNA's office in Glendale. As the protesters rallied, the company reversed its decision and said it would approve the transplant.

"This is an incredible turnaround generated by a massive outpouring around the country that proves that an engaged public can make a difference and achieve results," said Rose Ann DeMoro, executive director of the California Nurses Association and National Nurses Organizing Committee, one of the rally's organizers, reports KCBS.

Despite the reversal, CIGNA said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case.

In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent.

Officials with CIGNA could not immediately be reached for comment Thursday night.

Bottom Line results is a disaster in the health care industry. This industry is a disgrace, only Congress can straighten this mess out. We need to take the profit out of health care and let''s be realistic, socialize medicine time has come. These modern day carpetbaggers have priced them selfs into the stratosphere.

[susanhelit]

A vegetative state, and poor prospects - they might have made the right choice. That liver could have gone to a person with good prospects for survival. With organs, it is a choice - do we save her, or a different person - you have to choose - there are not enough organs to go around.

[j-whitman]

jowand,,,,, Obviously you don''t listen to the republican congressmen that come from the insurance lobbies

[jowand]

Don''t blame the insurance companies, doctors, or hospitals. Blame your local congressman, they are the ones who write the laws that allow this to happen. Some of them have been in goverment for 40 plus years and done sqwat, yet you will keep voting for them just because they are are a democart or a republican.

[connapa]

If the Physicians treating her felt that her only chance at survival was a liver transplant, they should have gone ahead with the procedure- with or without insurance company approval. They could have pursued reimbursement from the insurer after the fact. Just think if they had done that, and the girl survived, Then the insurer could not make the claim that it was not likely to save her life. Everyone involved in the case, even the parents (They could have signed papers saying that they would pay out of pocket for the procedure) share some responsibility.

[trueprogress]

Shame on our insurance system. What kind of care would the CEO" daughter get in this situation ?

[prinzowhales]

My error...in the last post of mine, "ascorbic acid" should read "citric acid."

[prinzowhales]

I hope people diagnosed with cancer will take a serious look at alternative cures before exposing themselves and their bank accounts to the US health care system.

Check out Colonel Joe Hart''s work with Oxyllic acid-- essentially it is juicing and an intake in foods high in oxyllic acid and low in things that deactivate it--like B-6 and ascorbic acid. Look at Doctor Livingston-Wheeler''s discovery of the Cancer microbe and her treatment modalities...and at the work of Max Gerson who cured TB and many cancers as well...his work is being carried on by his daughter Charlotte Gerson in California and Mexico.

Better yet, make sure you lessen your chances of getting the Big ''C''...keep your vitamin D levels up, make sure your selenium levels are good. Don''t eat the processed foods or take the petroleum-based supplements--eat real food...organic food...its good and good for you and you don''t have to eat as much to get the nutrition you need. Organic sprouts and wheatgrass that you grow yourself is really quite affordable...And the best part...every time you don''t get sick or get cancer, you cost the hospitals, doctors and pharmaceutical companies money...It really feels good to scr*w these b*stards!

[prinzowhales]

The people who killed her were the pharmaceutical companies, the insurance companies and the doctors... it was a real team effort...they must have really hated Nataline...

Dollars to donuts the drugs she got were hepatotoxic...did they try real healing?--I doubt it...they just killed her with FDA approved poisons...oh, well c''est la vie.

The insurance companies own drug company stock...it doesn''t matter to them how much the cost of care goes up...they just raise their rates.

Notice not one medicine was mentioned...not one treatment modality...just a ''complication'' from her bone marrow transplant...not one effort reported to save her liver function...and, do you really want to dump a fresh liver in a severely challenged patient already ''cross the threshold of death''s door?...And, just what happened to the leukemia? Did they ''cure'' the leukemia? Which drug do you think killed her liver...i''d like to see the record of her liver function tests, blood counts and the medication records thank you very much!

[drivelphobe]

Good morning brianbwb....

It is a fact that health insurance premiums are high and that the insured is constantly required to pay a larger share of each claim. This is a result of medical practitioners overcharging, fraudulent claims, harassment lawsuits, product design, government rules, and many other factors. We all suffer and dislike the tremendous costs involved.

Insurance companies are not endless reservoirs of cash to pay any claim submitted. Their obligations are pre-determined by contracts, subject, I might add, to the overview of the Department of Insurance in the respective state.

If insurance companies shouldn''t be for profit, perhaps neither should grocery stores. No profit, no product or service. Is that what you suggest?

Companies need to remain financially solvent to be able to provide the benefits promised in their contracts. Individual need has nothing to do with it. If a broke and starving person goes to a market, is the market supposed to give them the food free? Your argument is foolish and emotional, lacking in thought and facts.

Merry Christmas

[drivelphobe]

Good morning Mr.rudy654

Don''t even mention the millions of people who receive excellent service from the insurance companies, saving themselves from financial ruin. Just isolate a few examples where the insureds probably lied and cheated about their medical history, concocted a scheme to rip off the company, or are part of a fraud ring. You have no idea about what you speak. Insurers pay legitimate claims in a flash. They are not obligated to provide payment on the "expectations" of insureds as you simplistically suggest, but rather to the terms of the contracts. They have an obligation to investigate suspicious claims, of which there are many. There are hundreds of fraud rings composed of doctors, criminals, and attorneys who make money with phony claims and phony medical care. If these are allowed to go unchecked, there would be no insurance companies and then you would really scream. Wise up.

[laneykehel]

This is partially the fault of all Americans who vote. In our state, the two primary professions of the majority of our legislators are insurance agents and lawyers.

People complain that a national health care system would deny us the choice of physicians - most insurance companies already choose them for us. They also say we would have to wait longer times - I don''t see how =- now I take the entire day off for a doctor''s appointment because I''m usually there that long.

[brianbwb-2009]

Posted by drivelphobe

"Insurance companies issue contracts, legally defining their obligations."

Then at the time their obligation comes due, try their best to deny, redefine, or otherwise renege on the agreement, witness, for just one example, the Katrina victims denied because the insurance companies arbitrarily, and after the fact, redefined "storm damage" to exclude water damage.

"It''''s a matter of legal obligation. These are companies providing products and services and are entitled to make a profit."

All the more reason that the nation''s health care infrastructure should not be built around a for profit cartel that considers profit more important than supplying a vital service.

"They owe it to all their customers to remain financially sound."

If it comes at the cost of the denying vital health care to those customers, then they don''t, they owe their customer the care the customers expected at the time of entering the agreement. The exorbitant salaries paid to upper management should also be as tightly controlled and avoided as any other expenditures in the search for financial soundness. If they cannot hang, as the saying goes, then the same regard they give to a dying former customer, denied treatment because they don''t consider the patient to be "worth it", is only fairly due them, let them die.

[rudy654-2009]

Posted by rohink at 11:58 AM

Don''t think anything about this fellow. I suspect the poor fellow was beaten silly by some very abusive parents as he was growing up.

[rudy654-2009]

You should thank your lucky stars that insurance companies exist. The integrity of their products demands prudent stewardship over their claims and underwriting processes. Posted by drivelphobe at 07:17 PM

Oh okay. Thank you lucky stars for giving us greedy insurance companies that deny benefits to the people who work hard and pay them lots and lots of money. Thank you, thank you, thank you. And thank you for Mr. Drivel who reminds us of slobber that descends from the mouths of greedy insurance executives.

[troikasdaddy]

As I read this story my heart sank so deep and I felt so much sorrow for this poor girl and her family...and all those others who have suffered under similar circumstances. First, my heart and prayers to all those souls denied what should be rightfully theirs; in today''s world, in our nation full of its abilities it is absolutely disgusting and infinitely unforgivable that corporate greed and fine print have been given so much authority and further that it continues to be abused in such a way as to destroy all that each american heart holds sacred. Our firm support of capitalism and the belief that it is the only fabric capable of weaving democracy has imprisoned each of us so intensely, that you and I and all whom we love have become enslaved to practices of those profit-seeking organizations whose services we are forced to retain in order to live a free life, a life with a home, security, etc.

In my academic career I have seen, read, and experienced the most unbelievable realities and tragedies resulting from corporate greed and fine print fraud. My heart breaks for souls such as Nataline''s, for all of us who will one day face the ugliness of greed from those whom we want so badly to be there for us. Love is losing in our world WHY?! Is it so hard to love? Is it so tragic to lose a dollar for even the poorest man? Are we not overwhelmed? How long before we fight the evils of big business? Together, can we not fight and succeed in creating a world we love to look at and be a part?

[standlee5]

All consumers can do is check the ratings and financial standings of an insurance company. This is exactly why health insurance of all tings should not be in the hands of employer. People will always ***** about insurance but what would we do without it. Unless you''re rich and can be self insured. It''s actually a pretty brilliant idea, transferring individual risk.

[andor3]

"Major deviations can cause chaos in solvency and rate structure. They can''t pay what is not built in to their rates."

With some good editing, what that says is that the insurance companies are operating on such thin margins and paying so much that if they paid what they are supposed to, they would be bankrupt.

First, it is not true. Insurance profits are huge, and only a fraction of the income goes to patient benefits. They actually pay people to find ways to deny claims--they would rather pay that persons salary than pay for treatment.

Second, who cares? The insurance companies set up the system, and if they go broke paying what they agreed to, then they are just caught in their own web.

[andor3]

"if it was the right medical thing to do, and it was just a question of money, why did not the physicians, nurses and hospital do the surgery and adsorb the cost"

sure if the donation goes to help a needy family or patient. In this case the hospital would be donating to an insurance company making billions. why should they do that? make CIGNA pay as they should (and agreed to do, only too late). if hospitals and doctors started giving freebies to insurance companies who questioned medical need, there would be disaster.

[drivelphobe]

There is more here than meets the eye. The insurance company went the extra mile in attempting to provide extra-contractual benefits at great risk to their "usual and customary" procedures.

After listening to the father on the television, I definitely smell a rat. I sense he smells deep pockets, and feels little remorse about the death of his daughter.

The death of this young girl is a tragedy, however, she did have a fatal condition.

Insurance companies have contractual obligations and statistical information on which to base rates and claims'' practices. Major deviations can cause chaos in solvency and rate structure. They can''t pay what is not built in to their rates. They are to be commended for making a risky attempt to help this girl. Personally, I wouldn''t like to see companies take it upon themselves to provide any benefits that are legitimately excludable. It''s long range effects are deleterious.